Sunday, May 12, 2013

On Concussions

  I crashed my bike going downhill on a turn underneath a bridge on Tuesday. There had recently been some flooding. I didn't realize how much sand was on the path until it was too late. My tires lost traction and I wiped out. I propelled myself away from the bike so I wouldn't get tangled up in it and landed on my left side.
  I had thrown my arms out, so the impact when my face hit the cement was partially softened. I was also wearing a helmet, so my braincase didn't make contact with the ground. It could have been a lot worse (always wear a helmet!). I wasn’t paying attention to it at the time, but the soreness of my jaw the next day told me my teeth had clacked together fairly hard.
  I felt blood dripping down my cheek and when I pushed myself up, a decent-sized patch of skin over the heel of my thumb had been torn away and was now stuck to the cement. I stood up and the world was rocking back and forth. My balance wasn’t off, though, so I didn’t wobble. I moved off the path and sat down in the sand just to be safe.
  My mind was telling me that I had been thinking about various and sundry things just before the crash and that it was really important for me to continue doing so. It felt like I really had been thinking them, but it didn’t make any sense the more I thought about it- or rather tried to. I couldn’t hold on to any one thought for very long. I stopped listening to my mind and started taking stock of my injuries. Both of the heels of my hands and both of my elbows were scraped up. I felt big bruises on the inside of my right knee and on my left hip. The corner of my mouth was starting to swell and so was my left jaw. The cheek that was bleeding was swelling enough to obstruct the lower corner of my vision a bit.
  My bike was still on the path. So were my camera and the binoculars I had just borrowed from the bird club. I didn’t want anyone running over them or crashing themselves, so I got up and moved them off the path. My brain was still insisting that I needed to think about fake memories, so I didn’t trust myself to leave yet even though I felt physically able to. I went to sit back down and wait some more when my husband called.
  He was on his way home from work and was calling to say hi. After a short normal conversation aside from the part where I couldn’t remember a word I wanted to say, I told him I had crashed and could he come get me. I was staying very still. I didn’t need to move and I didn’t want to risk hurting myself more. He biked over, checked me out, and handed his lighter bike off to me. We walked them the ten minutes it took to get back home.
  He washed my wounds. I was still staying as still as I could. I panicked, got testy, and started crying a little when he bumped a large, painful, invisible bruise and when he wanted to treat my wounds in ways I didn’t want them to be treated. He put me in warm PJs and I laid down on the couch and took a nap.
  I didn’t think it was wise to go in to work, so a friend subbed for me. I tried to get some work done, but couldn’t concentrate on doing research.
  I had checked my pupils when we got home and they were normal. I hadn’t passed out and I wasn’t nauseous. I didn’t think I had a concussion, and my initial facebook post on the matter reflected that. My sister, who is a phenomenal emergency room RN, called several hours later. I was acting normal and feeling fine, if a little sore. I stood up quickly to take her call into the bedroom because we had been watching something on TV and I couldn’t hear her over it (I keep my phone on the lowest volume to protect my hearing).
  I told her my symptoms. She said it sounded like a mild concussion. When I was staying very still, I was in a type of shock even though I was aware and it seemed like I was choosing to do those things. You don’t need all the stereotypical symptoms to have a mild one. Because I would need to walk all the way to the hospital and they would give me an expensive MRI, she thought I should be okay not going to the doctor so long as I didn’t throw up and didn’t get worse. If I did, we would need to head there immediately. An older, more experienced ER RN confirmed her assessment and advice the next day.
  As we talked, I started feeling a little nauseous. I stopped talking and motioned for Gamble to take the phone as I hovered over the toilet and focused on breathing. I didn’t throw up and the nausea quickly passed. I had just stood up too quickly too soon after the crash when I answered her call.
  She told us what to do to take care of me (including waking me up halfway through the night to make sure my brain was functioning normally). I developed light sensitivity that evening, which tends to happen to me when I get colds or the flu. Gamble wouldn’t turn all the lights off because he wanted to be able to see me. He kept careful watch over me and I just focused on resting. I woke up in the morning with a small headache (it was gone by the end of the day).
  I was tired and spent most of Wednesday napping, watching Dirty Jobs on Netflix, or browsing the internet in short spurts. On Thursday, Gamble walked me into town to see one of my labmates defend his dissertation in the morning (he passed!). I stayed and listened to students give presentations in my last class of the school year. I went to the bar where my lab group was celebrating but got tired pretty quickly, so I went back home and rested some more. On Friday I was very tired and light-headed because some loud, rude neighbors woke me up that night and I couldn’t fall back asleep for the longest time. I was still tired on Saturday because I had pushed myself too hard on Friday after not getting a good night’s sleep. I slept more than I was awake. I feel more energetic today, but I’m still going to take it easy. I’m okay. I’m recovering.

  I’m telling you all this on my SCA blog so you have an idea of what you might expect if someone at an event, demo, or meeting shows these symptoms after a potential head injury. Even a mild concussion is no joke. Being able to identify one is especially important if the person who might have it is a fighter because they’re the ones most likely to find themselves in a situation where second-impact syndrome or post-concussion syndrome could occur.
  Post-concussion syndrome is basically an extension of your recovery. If you don’t get the rest you need shortly after the concussion, you can take months to heal instead of days.
  Second-impact syndrome is more serious. When you get a second head injury (even a very minor one) while your concussion symptoms are still there, your brain can swell very rapidly and herniate, resulting in death.  
  Chirurgeons- Strongly advise your fighters to sit out the rest of the event. Many will listen; some won’t. If you’re dealing with one of the “some”, tell their inspirations to keep on them about it if they insist on fighting anyways. Ask their shield brothers to keep a close watch on them and to take hits for them in melees if they can. Entreat their tournament opponents to be chivalrous and avoid headshots.
  Fighters- please don’t risk it. We would rather see you fighting again next month and for years to come. Risking your health and potentially your life isn’t valiant. Even if you don’t think you have a concussion (I didn’t at first), better safe than sorry. It’s surprising how mild the symptoms of a mild (but still dangerous!) concussion can be at first.

  Here are the symptoms to watch out for. Some may manifest immediately; others may show themselves over the course of the day or into the following weeks:
  •  any change in thought patterns after a blow to the head
  • headache/feeling of pressure in head
  •  dizziness/ being unsteady on your feet
  •  the world looking like it’s moving
  •  confusion/disorientation/amnesia
  •  falling unconscious (though this isn't actually common and isn't necessary for a concussion as it used to be thought)
  •  uneven pupils
  •  ringing in ears
  •  insomnia or excessive sleepiness
  •  sudden change in emotional response (irritability, crying, neurotic behavior, etc…)
  •  difficulty thinking of random words/ inability to concentrate
  •  nausea or vomiting
  •  slurred speech
  •  sensitivity to light or sound
  •  taste or smell being off
  •  dental trauma

Here are ways to reduce your risk of receiving one while fighting:

  • Pad your helmet well, but don’t overstuff it. You need to both distribute force and lengthen the amount of time your head spends slowing down and stopping. Have some money to burn? Use Kevlar padding. It stops bullets because it meets the two needs above so well.
  • Replace your foam padding fairly regularly. You’re supposed to throw a bike helmet away after a crash because the foam will have been condensed to the point of being less useful or even completely useless. Heads get whacked a lot in SCA fighting and they compress foam too. Compressed foam won’t slow down hits the way new foam will.
  • Wear a mouth guard to keep your teeth from clacking together. I have a friend who studies concussions and he says that clacking your teeth together actually plays a big part in whether or not you get a concussion and how severe it is. Enamel and dentine, the two substances that make up most of each tooth, are the hardest, most dense substances in the human body. The jawbone they attach to is the densest bone. When your teeth collide, shock waves travel through them very well and your jaw attaches right next to your brain cavity. You don’t want a big shock wave from your teeth and jaw being sent to your brain on top of the direct impact.
  • If someone is hitting way too hard, call them out on it. Maybe they’re from a harder-hitting kingdom and haven’t figured out how much to recalibrate. Or maybe they just aren’t thinking/being considerate. If they continue, report their unsafe behavior to a marshal. 

How to decrease your recovery time and reduce your risk of a second injury soon after:

  • Stop fighting. Even if it’s the first day of Pennsic and that’s the only reason you came. It sucks, but just don’t do it. The sooner you stop, the sooner you’ll be back in full form for later events.
  • Rest. Don’t go to post-revels, bardic circles, late balls, or camp parties. Get some sleep. Or even just lie there listening to the insects singing if it’s a summer camping event. Just don’t stay up late and don’t get up too early. Take plenty of naps during the days following the concussion. Take as many days off from work as you can manage and work as little as possible for a while.
  • Don’t think too much. Your brain is the pickiest eater of all. It only uses glucose, the simplest sugar, and right now that glucose needs to go towards repairing your brain, not using it. This is the one I’m having the most issues with. I need to think to do my work, but instead I’m having to force myself to be a couch potato. I can’t read books because it’s tiring. Even this post took several sessions to write because it was so draining.
  • Eat well. Keep that glucose coming in. Getting a balanced diet probably helps too. It couldn't hurt.

Males vs. females:   
  A lot of the information one can find out there about concussions are geared towards males because of all the male athletes out there getting concussions (especially in [America] football). Female secondary symptoms are often different from male secondary symptoms. I’m female, so the experience I described above might not align with what most fighters would experience. Males are more likely to be confused, disoriented, and experience amnesia. Females are more likely to be sensitive to noise, feel drowsy, and experience brain swelling (so the advice to stop fighting goes double for females because rapid brain swelling occurs during the potentially fatal secondary-impact syndrome). 
  Some studies show that females are more likely to get concussions (68% more frequent in female soccer players than in male soccer players). Other studies contend this point, saying that females show higher rates because our culture is more protective of them or because females are more likely to report symptoms. The jury is still out, but it seems like sports doctors as a whole recommend considering sex as a possible factor in how severe/frequent concussions are and how long to expect the recovery times to be. So, for now, be extra careful, female fighters.